Facial Muscles

Question 1

Frontalis

Answer 1

Action - elevates eyebrows

Cosmetic concern - horizontal wrinkles forehead

Originates - galae aponeurosis
Inserts - Dermis at level of eyebrows

Toxin effects - depress eyebrows

Question 2

Procerus

Answer 2

Action - medial and inferior pull of eyebrows

Cosmetic concern - Frown line over nose bridge

Originates - nasasl bone

Inserts - dermis at level eyebrows and lower forehead skin

Toxin effects - reduce horizontal frown between brows and less medial-iferior pull

Question 3

Corrugator supercilii

Answer 3

Action - medial pull of eyebrows

Cosmetic concern - Vertical ‘11’ frown lines

Originates - supraorbital bridge

Inserts - dermis at level eyebrows and lower forehead skin

Toxin effects - reduce vertucal frown between brows and less medial pull

Question 4

Orbicularis oculi

Answer 4

Action - closes eye. superior lateral fibres depress lateral brow.

Cosmetic concern - lateral fibres cause ‘crows feet’

Originates - frontal bone in 3 parts: pretarsal, preseptal and orbital

Inserts - preseptal and pretarsal insert into lateral canthus.

Toxin effects - reduce crows feet, brow lift when targeting superior lateral fibres

Question 5

Levator palpebrae superioris

Answer 5

Action - elevate superior eyelid

Cosmetic concern - nil

Originates - lesser wing sphenoid bone

Inserts - superior tarsal plate, skin of upper eyelid

Toxin effects - eyelid ptosis, adverse outcome

Question 6

Zygomaticus major

Answer 6

Action - lifts mouth corner superiorly and laterally

Cosmetic concern -

Originates - zygoma

Inserts -modiolus mouth corner

Toxin effects - Droop mouth corner, adverse outcome

Question 7

Frown lines - Target

Answer 7

Procerus and Corrugator supercilii (Glabellar complex)

Question 8

Frown lines - Dosage

Answer 8

20UI Botox - 5 injections of 4IU
50SU Dysport - 5 injections of 10SU

Question 9

Frown Lines - Injection & Technique

Answer 9

inject 1cm from supreorbital ridge

Procerus - half needle - intramuscular
Medial corrugator - full needle - supraperiosteal attachment
Lateral corrugtor - 1/3 needle - superficial

Question 10

Eyelid ptosis

Answer 10

Migration of toxin through orbital septum to levator palpebrae superioris. avoided by keeping injections in glabellar complex 1cm above brow

Question 11

Medial brow ptosis

Answer 11

caused by GC injections being placed too high

Question 12

Male vs female frontalis

Answer 12

Frontalis extends higher into hair line in men

Question 13

Procerus injection depth

Answer 13

intramuscular - half needle

Question 14

Medial corrugator injection depth

Answer 14

Full needle - supraperiosteal

Question 15

Lateral corrugator injection depth

Answer 15

1/3 needle - superficial

Question 16

Mentalis

Answer 16

pushes lower lip upward

Question 17

Depressor labii inferioris

Answer 17

depresses lower lip

origantes - oblique line of mandible

inserts - skin and submucosa of lower lip

inferior labial artery
mandibular nerve

Question 18

depressor anguli oris

Answer 18

pulls mouth coners downwards

Question 19

Levator labii superioris

Answer 19

pulls upper lip upward

Question 20

zygomaticus minor

Answer 20

Action - elevates upper lip at mouth corners

Cosmetic concern - gummy smile

Originates - zygoma medial to z. major

Inserts - oribicularis oris

Toxin effects - reduce gummy smile, drooping of mouth corners

Question 21

Nasalis

Answer 21

Action - nostril dilatopm

Cosmetic concern - bunny lines side of nose

Originates - pars alaris and pars transversa. Maxilla.

Inserts - alar cartilage

Toxin effects - soften lines on side of nose

Question 22

Depressor Septi

Answer 22

Action - Pulls nose tip down during smiling

Cosmetic concern -

Originates -Nasal spine of maxilla

Inserts - Lower lateral nasal cartilages

Toxin effects -

Question 23

Orbicularis oris

Answer 23

Action - Sphincter action of mouth

Cosmetic concern - smokers lines

Originates - maxilla and mandible

Inserts - Skin around the lips

Toxin effects - reduction of vertical lip lines, oral incompetence

Question 24

Depressor anguli oris

Answer 24

Origin - Tubercle of mandible

Cosmetic concern - sad look, jowls

Insertion - Modiolus of mouth

Actions - Depresses angle of mouth

toxin effect - reduces depression of mouth corners

Question 25

Mentalis

Answer 25

Origin - Anterior mandible Insertion - Chin Actions - Elevates and wrinkles skin of chin, protrudes lower lip Cosmetic - smooth chin dimpling

Question 26

Platysma

Answer 26

Origin - Subcutaneous tissue of infraclavicular and supraclavicular region Insertion - Base of mandible; skin of cheek and lower lip; angle of mouth; orbicularis oris Nerve - Cervical branch of the facial nerve Actions- Draws the corners of the mouth inferiorly and widens it (as in expressions of sadness and fright). draws the skin of the neck superiorly when teeth are clenched

Question 27

Masseter

Answer 27

Origin - Zygomatic arch and maxillary process of zygomatic bone Insertion - Angle surface of ramus of mandible, coronoid process Nerve- Mandibular nerve (V3) Actions - Elevation (as in closing of the mouth) and protrusion of mandible Cosmetic - square face with hypertrophy, TMJ dysfunction, burxism

Question 28

Risorius

Answer 28

Action - Draws back angle of mouth Cosmetic concern - Originates - parotid fascia Inserts - modiolus Toxin effects - drooping of mouth corner

Question 29

Buccinator

Answer 29

Action - mastication, compresses cheeks against molar teeth Origin - alveolar process of maxilla, buccinator rindge of the mandible Insert - modiolus Buccal artery Buccal nerve

Question 30

Levator anguli oris

Answer 30

Action - elevate angle of mouth Origin - canine fossa of maxilla Inserts - modiolus superior labial artery zygomatic and buccal nerve Toxin - mouth corner droop

Question 30

Pterygoids

Answer 30

elevstes and protudes mandible rotation and medial to lateral movements